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WHO AMONG US UNDERSTANDS MOVEMENT ???

July 11, 2013

**DISCLAIMER: With this discussion I do not intend to single out a particular point of view, nor a particular system, technique, philosophy, or the like. I simply want to put a flow of thought down into words (call it self induced therapy).

Now…this is a LONG POST…however there IS a point, which relates back to conditioning/manual therapy, and the like. One must only execute patient.

What I want to discuss is the concept of “movement” which has become somewhat of a “catch phrase” as of late in the world of training and manual medicine. In order to do so I think it first pertinent to discuss the perpetuator of movement, the nervous system and what we ACTUALLY know about it…

It would appear to me that conflicts and arguments occur on any topic most likely form in the areas of the topic that we know the least about. For manual therapy (and most medical discussions for that matter) that area of ‘blurriness’ seems to be regarding the function of the nervous system. Any neurologist/neuroscientist will tell you, although progress is being made at a staggering rate, that realistically they know very little about the one topic that they specialize in. This is not an attack on neurologist or brain researchers, only an admission that their ‘topic’ is one that is far, far more complex than is given credit for. Consider if you will that the human brain is estimated to be comprised of approximately 100 billion neurons. That is a lot of inventory to account for. Even simple tasks can involve several billion of those acting in a complex, interconnected fashion. Also consider the plasticity of the brain. New ‘connections’ are constantly being formed, lost, and altered, etc., ad infinitum.

Keeping this complexity in mind, it is almost inevitable that people will attempt to create conceptual frameworks or analogies in the hopes of trying to bring order to the disorder inherent to a lack of understanding. For the brain and nervous system, the “Central Processing Unit/Computer” analogy is the one most often called upon by all areas of science…including manual therapy. In other words, we most often take a mechanistic approach when contemplating the brain/mind thinking of it as a functioning computer. HOWEVER, one must ask them self, is this conceptual framework factual, or is it rather simply scientific dogma? In other words, do we actually know that the brain/CNS functions in this fashion? A look into the literature would suggest that we in fact DO NOT.

Consider the line of research pertaining to memory. We assume that memories are somehow ‘stored’ in the brain’s circuitry. Further that there is some magical retrieval system that is able to ‘find’ the memories and ‘upload’ them to our consciousness. This is a beautifully constructed analogy. Unfortunately, it is NOT based on scientific evidence; in fact, evidence contradicts this concept. Despite years of effort, and billions of dollars spent, no one has been able to “find memories” in the “hard ware” of the brain. Further, when complicating this topic, one must also consider the difference between “memory” and “recall of memory.” If we find that there is indeed a hardwired storage method for memories, there must then also be a “retrieval method” for which to extract these memories on demand. This raises yet another question…how does the retrieval system know where to find the memory that needs to be recalled? For this to occur we must assume that the retrieval system itself has a form of memory. This problem is one of infinite regression where memory is needed to find memory…which also requires memory??

We can also consider the lines of research that looked at what happens when animals are taught concepts (assumed to be stored as memory), and then large sections of their brains were surgically extracted. What was the result? It did NOT affect the memory. They were able to effectively recall the memory as they did before. Some studies also looked at motor processing in the same way. Teach a motor task, then remove large sections of the motor cortex….what happens? Nothing. The physical ability remains. I KNOW that this sounds impossible, but it has indeed been shown!

Other studies have noted that humans with severe hydrocephaly at birth leaving them with only a small portion of a ‘normal’ brain were able to carry on ‘normal lives.’ Others point to our complete lack of understanding of consciousness, as well as the difference between the ‘brain,’ and the ‘mind.’

Anyway…..bringing this back to the realm of manual therapy…

Based on the above information, one must question a theory that is constantly utilized by manual therapists to describe the execution of movement – “Motor Engrams/Programs.” We use this concept in order to try to understand movements and how they are executed and/or controlled. However, is their existence reality, or an attempt to simplify an otherwise poorly understood concept? Appraisal of the scientific evidence available favors the latter.

When we observe ‘movement’ and/or try to categorize, interpret, or grade it, we are doing so with a pre-conceived notion that we have a good grasp of how that motion is performed, remembered, and recalled time and time again. However, we DO NOT. The truth is that movement involves extremely complex combinations of neural integration (or so we think) in a highly plastic brain, made up of BILLIONS of neurons, which are CONSTANTLY changing.

Based on this line of thinking I pose the following questions:
– If we know so little about how movement patterns are stored and executed, than how can one claim to know the ‘correct’ way for someone to move? (Especially considering that the BILLIONS of neurons, and the uncountable number of interconnections are constantly changing. Further that we are only ASSUMING that a particular movement created by one individual is ‘run’ with the same, or at least a similar neurological pattern as another person)

– Can we grade anyone as a “good” or “great” mover based on observation of a series of set movements?

– If we can grade someone as a “great” mover….can we assume that when run through a battery of movement screens or tests, that they will fare better than someone who is a “bad” mover? (I ask this question as I have seen first hand a cirque du solei performer who scored poorly during a simple movement screen)

– Do we have to grade movement? Or can we just concentrate on optimizing articular function/mobility thus improving the POTENTIAL for movement?

– Can anyone claim to truly understand movement?

Again this is not an attack at anyone attempting to categorize movement, grade it, assess it, or correct it. I in fact have the UTMOST RESPECT for each and every person who is currently pioneering these concepts. Perhaps these proposed methodologies will indeed yield beneficial clinical results in the future. However I think it important to really think about the knowledge base available from which to create the theoretical constructs with which to do so.

I propose another way of tackling the problem of movement in my seminars. The way that I interpret the literature and clinical observations regarding movement are as such…

We know that the more complex the movement, likely the more complex the originating plan executed by the nervous system (note that I did not say the more complex the plan created by the nervous system as we cannot logistically make that claim). We also know from research in exercise physiology that training results seem to be VERY specific to the type of training itself including rate of loading, angle of loading, frequency of input, etc. Thus when assessing movement by asking a person to perform a movement ‘test,’ we cannot account for:

1. Their history of performing similar movement tasks
2. Their history of actually performing the test

After providing exercises to ‘correct the test’ we then cannot account for:

1. The familiarity/learning effect of having previously performed the test
2. Any further complexity of performing the test
movement in uncontrolled situations.

I therefore wonder if we should be assessing and correcting for the test, or should we simply be assessing the articulations involved in said movement looking for dysfunctions that would decrease the ABILITY of the nervous system to do its job? I tend to lean towards the latter. My systems look to assess articular function…not against a pre-conceived “optimal joint function,” but rather to get a baseline of its function. I then consider it our job to induce functional improvements via therapeutic and/or training interventions. Once we are dealing with well functioning articulations, I then want to begin patient/client on a movement-training program with ever increasing neurological complexity so as to build their ability to move.

This can be summed up by my equation:

Mobility ∝ Movement Potential
(where mobility is directly proportional to movement potential)

Mobility simply refers to the amount of active motion capable in a particular articulation (a concept wrongfully, and commonly used as a synonym for ‘flexibility’). It would seem through my experience of training myself, training others, and spending much of my time as a manual therapist, that this equation is clinically accurate. One cannot execute a movement task if one, or several articulations involved in said task lack the necessary mobility (the ACTIVE ability to created the ranges needed). Once the necessary articular mobility is achieved, the nervous system will be free to gradually learn the necessary neurological execution to create the movement.

I thus conclude that in order of importance, we must first assess, and correct/improve the capability individual articular function as this is a pre-requisite of sorts. Then and only then can we expect the nervous system to learn, and subsequently execute the movement pattern. If we reverse this sequence by observe someone’s movement capability first finding deficiencies, this does not negate the need to assess individual joint function which, unfortunately, is a common occurrence as many practitioners immediately prescribe ‘corrective’ exercises in an attempt to correct “the movement” itself.

In reality “the movement” does NOT exist, as there is an infinite number of confounding variables making each movement execution distinctive. We therefore should focus on improving movement…not “the movement.”
In conclusion, it is my opinion that the best way to improve movement capability is to prepare the body for movement in general…and then practice moving.

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12 Comments leave one →
  1. July 11, 2013 2:31 pm

    Thank you for sharing your thoughts and your emphasis that mobility is ACTIVE. Seeing the proportionality, I will absolutely rekindle my mission toward greater and functional mobility.

    I do have a question about something in particular. I see an ART specialist and a physical therapist (two different people) for isntability I feel is in my right shoulder and thoracic spine (also only the right side.) My right shoulder has a fantastic range of motion but I find that it doesn’t “set” quite right. When I roll it back to try to get it into what feels like the right place, my ribs, neck, and chest make incredible sounds and I feel that I am grinding every rib I have.

    How do I get these to go away? How to I restore stability to my right side? How to I get rid of the pain?

    If you can’t address these questions directly that’s totally fine. I did get an MRI and an xray of my thoracic spine and I have a slight bit of scoliosis as well as a slightly degenerating disc, but nothing, apparently, related to the grinding and the instability I feel is my chief complaint.

    Thank you again!

    • July 11, 2013 3:35 pm

      Thank you for the comment.

      As you noted…it would rally be impossible for me to give you any answers, or suggestions for your problem without assessing it myself unfortunately…apologies 😦

      • July 12, 2013 12:55 am

        no worries at all! perhaps one day i’ll be lucky enough to be assessed by you. until then I will continue to experiment and learn!

  2. Darren Veira permalink
    July 11, 2013 2:56 pm

    Excellent post, Dr. Spina. I recently discovered your material online and find it to be very useful and sensible. It compliments my movement training nicely and has been very educational. Thank you for your work and your posts.

  3. July 13, 2013 12:19 am

    What an excellent article! I did my undergrad in neuroscience and a lot of what you said really rang true and got me thinking again.

    Cheers!

  4. Tyler Satnick permalink
    January 31, 2014 6:23 am

    Dr. Spina, my take from this post is that you don’t buy into Fundamental/Archetypical movement patterns/shapes and that by assessing someone with them we get an incomplete/inaccurate picture of the function of someones body? You measure the success of “corrective” work based solely on whether someone has normal/full hip and ankle flexion not that they squat well? You are an extremely capable professional. I’m POSITIVE you can learn so much more about a persons body watching them move vs knowing what ROM each joint in their body has (is it even practical to try to discover such a thing?) General should always taper to specific (can you reach over you head with integrity, vs do you have optimal clavicalar motion) Many elements produce poor movement that have no effect on joint ROM. To me you are confounding the issue in regards to the Nervous system. fundamental movement screening/standards with the subsequent goal of improvement is a way of integrating the mobility improvements you described with the control needed to execute them. We know that in order to pull off these tasks or positions we must have full mobility anyway, these movements/positions are a great way of challenging an entire system to show its normalcy which is why we focus on and choose them for screens or movement standards. are they specifically innate to our nervous system? probably not. but they do allow us to see how well all systems are functioning/will function in a way that has a higher transfer/reliability than joint ROM measurements. Do you need to use a movement screen? NO. But i strongly believe you need movement principles and standards and the ability to assess the function of someones body based on ANY movement you like, as long as it demands normal function to express/complete it. i really think your philosophy is very sound, just as you have a standard for someones joint motion (which I also share) I have a standard for their ability to apply it to basic positions and shapes as a clearance for adding stressors and progressions related to them. Thoughts? Am i barking up the wrong tree here?

    • February 1, 2014 5:17 pm

      Hi Tyler

      By the sounds of i, you are also a very capable professional. However I think you misunderstood. I care very, very little about a persons ROM actually. Rather, I care about how much of their passive ranges they are able to active in a controlled fashion (mobility). When I am assessing a person, I want to discover how much range they have (actively)…if they need more to accomplish a particular movement, I believe our first job is to ‘grant them access’ to it…and then practice the movement. However to assess “movement” is far beyond the knowledge that we currently have (listen to McGill’s argument when he debated Cook). There are just TOO many variables in a movement. Further, there is no such thing as movement reproduction anyway…no matter how hard one tries. Take a pro golfer who has practiced the movement millions of times…they still tank balls. Thus whilst ‘movement’ exists….”THE” movement does not…and thus why try to assess it? I believe it time better spent to ensure that the movement pre-requisites are there (active joint control)…and the then the movement can be trained subsequently. When variables come into play (ex. a lineman is hitting a quarterback during a throw) I care more that they have developed the articular control, AND joint tissue strength to absorb the load…vs their ability to throw (as that is taken care of by practice)

      thanks for the question. I believe we are ALL likely barking up the wrong tree ultimately btw 🙂

      • Tyler Satnick permalink
        February 1, 2014 10:06 pm

        Thank you so much for your reply. My new question is how do you qualify someone for loaded or non-supervised stressful movement? If you don’t believe in chasing an ideal movement pattern how do you know when someone has gained competence or mastery of one? My question is, how do you decide when someone is up to snuff with a movement? When does it become trainable or progressable to you? Obviously once they have full ROM it is trainable from the standpoint that it’s time to discover if stability/control is a limiting factor followed by discovering if mobility+ correct stabilization strategies actually allows them execute the base pattern well (it does, unless it’s structural) . Then I need to see if it can be applied to a more complex pattern, of course related to the basic pattern, but usually a regressed variant, then a progresses one. Beyond that the ability to show consistency of movement and competency interacting with an implement in question then becomes my main focus. Never moving into a state of fatigue or load that causes noticable breakdown of quality. And when those factors don’t effect movement quality that is true mastery! What more is load and fatigue then a way to challenge movement? So example of the process is:

        Deadlift base requirements
        1. Acceptable hip, ankle range, etc.
        2. Acceptable spinal awareness/stability, hip stability, etc.
        3. Acceptable hinge pattern (unloaded)
        4. Acceptable elevated deadlift (Loaded, regressed)
        5. Acceptable barbell deadlift
        (Loaded, progressed)
        – And from there the client is opened up to more complex deadlift tasks, explosive variants, etc. if desirable.

        As a snapshot of your thinking, how would you qualify a client to deadlift? I think that might clear up my confusion more than further explanation. Thanks again, having a good time with this discussion!
        -Tyler Satnick

      • Tyler Satnick permalink
        February 1, 2014 10:25 pm

        Also I do want to say that movement does have a million variables. But in the gym the movements are simple enough that reducing variability isn’t that difficult and when acute demands are high enough it is an absolute must especially when factoring in a considerable frequency and volume of stress application. The ideal patterns are designed to say one thing, if you can do this to standard, we have hypothesized that you are normal enough to apply those systems to related tasks. I want to believe in a high correlation between hinging/squatting/pushing well and the linemen setting up and expressing force properly. Can he control all the variables? No but it gives him a distinct advantage possessing those qualities. That “standard” is based on movement principles like “the spine is more stable and transmits the more force closer to a neutral shape and needs to be reenforced properly to fully express this quality” ” the hip and shoulder systems stabilize using proper rotational bias and must be aligned in a way to maximize this” “Full ROM of the task should be achieved without compromise on the above” etc.

      • February 4, 2014 12:21 am

        Hey Tyler
        First, regarding when you said that I “don’t believe in chasing an ideal movement pattern” I think it important to say that in fact I absolutely do. Does one exist for any particular movement…imo no in and of itself. In my eyes the only way to determine the ‘functionality’ of any movement is in retrospect when contrasted against the goal the movement was meant to obtain. There is of course more or less efficient ways to reach an end goal (straight bar path with deadlifting for example)…but the movement itself is stored in the motor cortex not as an exact ‘program’ (I hate the brain as a computer analogy but that is the common terminology) but as a general execution of neurological tasks that is constantly compared to the goal and altered accordingly on a moment-by-moment basis. So you see, even the CNS understands the infinite variability of movements (even the ‘simple’ ones you noted in your third comment.

        Aside from all of that, I will state again that I have no problems striving for an ‘optimal’ movement, I only cringe when a practitioner believes they know what it looks like from doing a series of pre-determined “screens.” This concept is fundamentally problematic an flys in the face of the specificity principle entirely.

        I suppose then what I most have the issue with is the assessment of movement when put against a pre-determined standard (which doesn’t exist).

        How would I know when it is ok for a person to perform a movement? I would first break the movement down into the required mobility pre-requisites for each articulation involved (recall by a “mobile” joint I am referring to one that has both the ROM, control, and load bearing capacity…and hence stability). I then assess to make sure these pre-requisites are met, then we practice the movement in a progressively more challenging variation as you noted (no load, to load, to increased complexity, etc.)

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